Wiki Depo Provera

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MWilliams01

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Does anyone have the correct HCPCS code for Depo Provera in 2013. Codes J1055 and J1051 have been deleted as of 1/1/13.
 
The new code states 1 mg. Does this mean that when we bill for it we do 150 for the units? We give doses of 150 mg.:confused:
 
J1050

I resent in a claim using the J1050 @ 150 units linked to the V25.02 code which we alwayse used in the past to be paid on the depo provera and it was denied from Aetna the reason for denial this HCPCS Code J1050 is not valid or needs to be coded to the highest degree of specificity.
 
J1050

I called Aetna I spoke to someone there and it looks as if this maybe a clearinghouse issue. The lady I spoke to her name was Linda she said she did not have any record showing of the claim ever being received or denied. Plus she said in the Aetna system the code J1050 is still a valid code to them. So based upon that is sounds like the clearinghouse is stopping it. I have a call into my clearinghouse vendor they are looking into this I will let you all know what I find out.
 
J1050

OK, I heard back from my clearinghouse they said that the description was not coming through to them for the code? So I called my software guy he had a look at it and after a long discussion we figured out that there was a change made on Jan 1/2013 to the billing method of the J1050. The J1050 must be billed with modifier U1, and is appropriate for the purpose of contraception( as a replacement for the procedure code J1055) This information is directly from the Texas Medicaid Special Blulletin it is called the 2013 HCPCS Special Bulletin. It contains 42 pages and it is packed with a ton of info. So I have resent the claim again with the U1 modifier. I will keep you posted as to what happens.
 
Depo Provera J1055

I question whether we should be using the J1050 as this represents 1mg/ml and may have a different NDC# vs the old J1055 which was 150mg/ml -
Nobody seems to have a good answer as how to bill this appropriately. Checked with Cigna and Aetna and couldn't get an answer here in Maine.
 
We used CPT J1050 with 150 units using a dx 625.3 on a CGS Medicare patient. The claim was processed just fine with an allowed amount on the J1050 of $30 to deduct. Fingers crossed that we have no problems with other payers!
 
You said you needed to use a modifier, are you applying the U1 on the claim line item J1050? The reason I ask, I was told to add the U1 to the end of my NDC# in the appropreate field on my claim. After reading your message now I'm not sure which place to apply the U1. Please clairify where you applied the U1.
Or was the U1 added by your sofeware IT agency?

Sorry for the confusion just wanna get it straight.
Thank you,
LB
 
j1055

Have called AAPC, AMA, NHIC (which the AMA told me to contact as they handle the HCPCs supposedly) and have got no where. It's like no one understands the dilemma that J1050 does not in any way shape or form equate J1055 without fudging the info i.e. NDC# but am still pursuing as I am tenacious to get to the bottom of what I think is an error in the HCPCs on someones part. :D
 
Does anyone know in the state of WA if we need to use a modifier for the new depo code? I have been billing the J1050 with 150 units, but was informed some payors will not pay with that many units, it's confusing to me... :confused:
 
Thanks for the info. i will be watching closely to see what happens with payment from MCD. On another related subject, would anyone know what cpt codes to use for well woman annual gynecological exams for medicare? Medicare does not use 99384-87, or99394-97 preventive med. E&M codes. My predecessor used a regular E&M code as the visits are almost always comprehensive and involve a multitude of gyne complaints, that go well beyond a v72.31 DX code and pap smear. The major problem with this is that annual exams are exempt from deductible and co-pays, and a regular E&M code will not recognize this. Also, have they bundled the pap smear into the annual, so it is now unnecessary to keep track every 2 years for billing? Could someone give me an example of a cpt and dx coding for medicare annual exam?
 
Depo & Annual Gyne exam

Thanks for the info. i will be watching closely to see what happens with payment from MCD. On another related subject, would anyone know what cpt codes to use for well woman annual gynecological exams for medicare? Medicare does not use 99384-87, or99394-97 preventive med. E&M codes. My predecessor used a regular E&M code as the visits are almost always comprehensive and involve a multitude of gyne complaints, that go well beyond a v72.31 DX code and pap smear. The major problem with this is that annual exams are exempt from deductible and co-pays, and a regular E&M code will not recognize this. Also, have they bundled the pap smear into the annual, so it is now unnecessary to keep track every 2 years for billing? Could someone give me an example of a cpt and dx coding for medicare annual exam?
 
Depo reimbursement

I was just wondering if any of you are experiencing lower reimbursement for Medicaid and BC/BS patients when they receive Depo Provera, we have been billing J1050 with 150 units and are reimbursement this year doesn't even cover the cost of the drug we are losing money. Are any of you experiencing the same thing and if so how are you handling this to offset your costs now? It was suggested charging nurse visits when they come in for the Depo shots, having the nurse document vitals and giving information to the patient regarding the drug. I am not really comfortable doing this as I really don't feel its appropriate, but the doctors don't want to stop giving the Depo either. Thank you for your help.
 
depo J1050

I have finally figured this out for our office. We are billing J1050 150 units @ $.47 per unit to =$70.50 charge......our issue was our internal fee schedule. Once I corrected the fee schedule to bill out 150 units @ the $.47 cents we are getting anywhere from $30.00-$42.00 reimbursement for the injection alone. But due to the issue prior we have decided as an office to write RX scripts for patients to get the med at the pharmacy and bring in for us to administer the injection. Hope this helps anyone still having issues!! :)
 
Does anyone know what the correct DX is for reporting the depo injection? V25.09? V25.9? V25.49? I can't seem to find anything that is definitive.
 
ob gyn

There was notice in the February 2013 copy of the AAPC Cutting Edge on page 23 of changes for the J codes:)
 
raines99 said:
OK, I heard back from my clearinghouse they said that the description was not coming through to them for the code? So I called my software guy he had a look at it and after a long discussion we figured out that there was a change made on Jan 1/2013 to the billing method of the J1050. The J1050 must be billed with modifier U1, and is appropriate for the purpose of contraception( as a replacement for the procedure code J1055) This information is directly from the Texas Medicaid Special Blulletin it is called the 2013 HCPCS Special Bulletin. It contains 42 pages and it is packed with a ton of info. So I have resent the claim again with the U1 modifier. I will keep you posted as to what happens.
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Was the claim paid?
 
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